Managing the 3rd stage of labor, dr.rhodora cruz,bulacan ob g

1,953 views
1,505 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,953
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
90
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Managing the 3rd stage of labor, dr.rhodora cruz,bulacan ob g

  1. 1. Managing the 3rd Stage of LaborPrepared by: Violeta Manalang-DeGuzman,MD,FPOGS Bulacan Medical CenterPrepared on: January 31,2009Presented by: Eva Felipe Dimog, RM, BSPH University of La Salette Santiago City
  2. 2. Objectives Define the 3rd stage of labor Enumerate the signs of placental separation Describe the management of the 3rd stage of labor
  3. 3. Third stage of labor Placental stage Usually last for 30 minutes
  4. 4. Managing the 3rd Stage of LaborThe following are signs of placental separation except:A. A gush of blood comes from the vaginaB. Umbilical cord gets longerC. Uterine fundus palpable beyond the umbilicusD. Uterus becomes round in shape
  5. 5. Signs of placental separation A gush of blood comes from the vagina Umbilical cord gets longer Uterus rises over the abdomen Uterus becomes round in shape
  6. 6. Management of the 3rd stage of labor Expectant Active
  7. 7. Expectant management Talk to the woman and tell her that you will deliver her placenta Wash your hands and put on your sterile gloves
  8. 8. Expectant management After having the signs of placental separation, hold the clamp close to the perineum with one hand. Deliver the placenta by putting one hand just above the pubic bone. Tell the mother that she can strain when there is uterine contraction
  9. 9. Expectant management Gently guide the placenta downward and outward by holding on the cord. Be gentle because a hard pull can tear or break the cord and even worst, turn the uterus inside out As the uterus stays in place and the cord gets longer , continue to guide gently until the placenta is delivered
  10. 10. Expectant management When the bulk of the placenta is out,hold it with your two hands Rotate the placenta like twisting a rope until delivered so that the fetal membranes will come out also
  11. 11. Expectant management Feel the uterus from the abdomen and massage it to keep it contracted Inject an oxytocic drug intramuscularly
  12. 12. Management of the 3rd stage of labor The best time to inject oxytocics during the 3rd stage of labor according to RA 7392 is A. After the delivery of the baby B. After the delivery of the placenta
  13. 13. Philippine Midwifery Act of 1992 (Republic Act 7392)…..allows midwives to give oxytocics AFTERdelivery of the placenta and if they haveundergone training for it.
  14. 14. Active management of third stage of labor Injection of oxytocics after the delivery of the baby Controlled cord traction Massage of uterus
  15. 15. Active management of third stage of labor Requires proper learning and training Controlled cord traction may accidentally break the cord or invert the uterus when the placenta is adherent Midwifery Act of 1992 (RA7392) only allows midwives to inject oxytocics AFTER delivery of the placenta
  16. 16. Key Learning points Wait for the signs of placental separation prior to its delivery Do not pull the umbilical cord if it is still attached to the uterus to prevent cord breakage or uterine inversion Inject oxytocics only AFTER the delivery of the placenta Always inspect the placenta for completeness of membranes and cotyledons.
  17. 17. References Elbourne DR, Prendiville WJ , Carroli G, Wood J, McDonald S. Prophylactic use of oxytocin in the third stage of labor.In: The Cochrane Library,Issue 3, 2003. Oxford. Update Software. Joy SD, Sanchez-Ramos L, Kaunitz AM, Misoprostol use during the third stage of labour. Intl J Gynecol Obstet 2003;82:143-152 Prendiville WJ, Elbourne DR, McDonald S. Active vs. Expectant management in the third stage of labour. In: The Cochrane Library, Issue 3, 2003. Oxford. Update Software WHO, UNFPA,UNICEF, World Bank. Managing Complications in Pregnancy and Childbirth. WHO/RHR/00.7,2000. Alejandro R. San Pedro, A Handbook on Postpartum Care, A Clinical Guide on Care of the Mother and Newborn, Philippine Midwifery Series Book 2, 2007

×